How Mbeki won the great AZT and rape debate Independent Online http://www.iol.co.za October 09 2000 By Robert Brand Ask any ordinary South African if the drug AZT prevents HIV in rape victims, and the answer most likely would be yes. Some of the better-informed may add that the government refuses to provide AZT to rape victims, and that President Thabo Mbeki had turned down an offer from the manufacturer of cut-price AZT for that purpose. They would be wrong. In fact, there is no scientific evidence that AZT prevents transmission of HIV to rape victims; and Glaxo Wellcome, the manufacturer of the drug, has never offered the government low-price AZT for the purpose of treating rape victims.
On June 13, Leon told parliament: "To quote the words uttered on May 10 this year by Charlene Smith who, herself, survived a horrific rape ordeal. Listen to what she said about the government's and the president's stance: 'If, instead of spending vast amounts of money on recreating the wheel, President Mbeki had taken up the Glaxo Wellcome offer - the lowest in the world at R200 for 28 days' supply of AZT - and made it available to rape survivors to prevent HIV, 10 000 rape survivors in South Africa would have got the drug. Eighty percent of them would not have sero-converted and become HIV-positive if raped by an HIV-positive person.' As the Americans would say: case closed." In his response in the same parliamentary debate, Mbeki challenged Leon's view: "... AZT is not licensed in this country for that particular purpose. The manufacturing company itself says that AZT is not a vaccine and therefore it cannot work in these circumstances, which is why they have never applied for the licensing of AZT for that purpose in any country." From the floor, an unidentified MP interjected: "What about the offer they made you?"
Leon, from the floor: "But they made an offer!" Mbeki: "No, Tony, they did not ... it is very easy to check this one. We just need to phone Glaxo Wellcome tomorrow." On June 19, Leon wrote Mbeki a letter in which he reiterated his view on the use of AZT on rape victims and, a week later, he forwarded a letter to Mbeki from the Glaxo Wellcome chief executive, John Kearney, to back up his claim. Kearney's letter, addressed to Leon and dated June 27, said: "... I am pleased to confirm that your reply to the president is essentially accurate on the scientific aspects of using AZT as post-exposure prophylaxis in individuals who have been raped. Together with you and your party, we look forward to the day when all individuals who have been subjected to the horrific crime of rape will have the opportunity to access anti-retroviral prophylaxis." Anyone who followed the debate this far could be forgiven for thinking the scales had tipped in Leon's direction. Kearney's letter is a confirmation of Leon's statement that AZT can prevent HIV infection in rape victims, and that 80 percent of women who are raped by HIV-positive assailants could be saved through administration of the drug. What's more, Kearney's letter did not deny Leon's contention that Glaxo Wellcome had offered the government low-price AZT for the treatment of rape survivors, and that the government had turned the offer down. The inescapable conclusion is that it must be true. On July 1, however, Mbeki replied in writing to Leon that the scientific literature did not support his, and Kearney's, contentions. Quoting at length from a report by the America's Centres for Disease Control (CDC), Mbeki pointed out that no scientific data existed to support the theory that AZT can prevent transmission of HIV to rape survivors, and that the CDC in fact cautions against the prescription of AZT as a "morning-after pill" because it is a dangerous drug with severe side-effects. The idea that AZT can prevent the transmission of HIV to rape victims is deduced from studies that show that the drug reduces mother-to-baby infection. Whereas one-third of babies born to HIV-positive mothers contract the virus, the chance of infection from a single episode of vaginal sex is held to be extremely low, estimated by the CDC as 0,1% to 0,2%. Drug activists say that, because rape often involves physical injury, the chances of infection would be higher. But the risk of infection for rape survivors and the efficacy of AZT in preventing it remain scientifically unproven, as does the balance between the drug's risks and benefits for them. Mbeki pointed out that Glaxo Wellcome must have been aware of the CDC's position, which was why the company had not registered the drug for use on rape survivors and did not mention this use in its package inserts. He added: "I am very disturbed at Mr Kearney's statement that your incorrect statements about AZT and rape are 'essentially accurate on the scientific aspects ..." The CDC is not a crackpot "dissident" group, nor is it prone to conspiracy theories. It is internationally recognised as an authority on communicable diseases - which perhaps explains why, after publication of Mbeki's letter in the Sunday Times, Kearney sent the following statement to that newspaper: "Glaxo Wellcome first offered preferential pricing of its two anti-retroviral products, AZT and 3TC, to the South African government for use in the public sector in 1997 ... The exchange between the President and Leon implied that this pricing was also offered for use following rape, causing concern at Glaxo Wellcome because AZT is not registered for this purpose. "The company has not engaged in any price or supply negotiations to provide AZT for use in rape survivors, nor does the company promote the product for that indication. Leon has therefore misinterpreted the company's offer. President Mbeki is correct in pointing out Glaxo Wellcome's package insert for AZT does not mention the medicine's use in rape situations ... it has not thus far been possible to carry out clinical studies relating to the use of anti-retrovirals in rape survivors." In other words, Mbeki was essentially right and Leon wrong. Yet in Kearney's earlier letter to Leon, he did nothing to discourage a view he admits is erroneous. And Leon himself has said nothing in parliament or elsewhere to correct his "misinterpretation". In the meantime, the "misinterpretation" has become dogma: a good part of the world now believes that the South African government is irrationally and callously refusing to provide cut-price, life-saving drugs to survivors of rape. Can you blame Mbeki for believing there is a conspiracy?
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